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I <br />ELEGTRICAL.I NSPECTOR RECORD <br />APPROVALS DATE ID/SIG COMMENTS <br />Site-Work <br />Underground <br />Pole Bases <br />Light Standards <br />Spas, Pool, Fountains <br />Signs (monument) <br />Life Safety /Low Voltage <br />Fire Alarm / Dampers <br />Communications Cable <br />Building <br />Under Slab / Floor <br />Bonding I Grounding / UFER <br />Transformers <br />Torquing <br />Sub-Panels <br />Air Conditioners <br />Roof Top Equipment <br />Factory Wired Unit <br />Walls (Conduit) <br />Walls (Rough) <br />Ceilings (Hard & Soffit Rough <br />Ceilings (T-Bar Rough) <br />Meter Release <br />l.-T <br />Rough 4 1 tlgov a%/) <br />Service Meter *l-,lt /(v <br />FINAL '4 lzl?L >ft#fl <br />Notes, Remarks, Etc. <br />Owna-Builda Dccl[stid <br />I hscby allim undq pcsalty of pcrjury thst I m cxmpt fom thc CotrtmctoE' Limsc Irw for thc following l@ (s@.7031.5 Auinl; <br />md Prcfxio Codc): Any City q County which rcquiru a pcmit to ffistruct, altcr, improvc, dcmolish or rcpafu ey structm, priq to its <br />isumcc, also rcquirc thc appliot fo such pcrmit to filc a sigrcd statmdt that hc s shc is limscd pmuut to thc Fovjsios of thc <br />Cotrtretor's Licqscd Lsw (Chapt6 9, Cmcncing with Sation 7000 of Division 3 of thc Buins ud Prcfsions Codc) or rhat ln a <br />sh. is cx@pt th@frm ud thc bsis fa thc allcgcd amptio .Any violatio of Setim 7031.5 by ily applicut for I Imit subjcrs rllr <br />agplimt to a civil pcnalty of not mnc the 6vc hundrcd dollm ($500). <br />/\ u wta of thc propcny, u my mployu with wagc s thcir rclc comprnsation, *ill do thc work ed thc structuc is not inrmdad <br />br offqrd fc sslc ( Se.70il4, Bsins dd Prcfsim Cod.: Thc Contuts's Licasc Law dc trot apply to m owncr of thc propcrgr <br />who builds u impova thron, ad who dq such wor* hirelf or h6clf tr thrcugh his or ho m cmployo, providcd that such <br />imprcvmots re not intadcd or offcrpd fq salc. I( howoa, thc building o imprcvmot is sold within oc yo of cmplaim, thc <br />Ownq-Buildq will hsvc thc burda ofproving that hc or shc not build q improvc for thc purposc ofsalc). <br />_1, as owner of the propcrty, am <br />Profession Code: Thc Contractor's <br />exclusively contracting with licensed to construct the ( Sec. 7044, Bruiness and <br />Licensc Law does not apply to an owncr of who thcreon , and who <br />contracts for such projects with a Contracto(s) liccnsed pursuant to thc Licensc <br />_l arn exempt undcr for <br />Datc: <br />I hereby aflirm under penalty of perjury one <br />_lhavcmdwillmaitrtain&CcltificdaofcmffittoSclf-Insurcforworkm'cmpcns*io,o prcvidcdforbyScctio3TOOofthc <br />Labor Code, for thc pcrformancc of the work for which the pcrmit is issued. <br />and will maintain workers' compcnsation insurance, irs requircd by Section 3700 of thc Labor Code, for the pcrformancc of the <br />work for which this permit is issued. My workers' compensation insurancc carrier and policy numbcr are: <br />Carrier <br />Policy Number I Expires: <br />(This section need not bc complctcd if the pernrit is for One hun&ed dollan {$l0O} or less) <br />I shall not pcnon in any manner so as to <br />aSree if I should subjcct to the workers' <br />compcnsation of Section 3700 of the Labor Code, I with <br />\ <br />WARNING: Failure to secure workers' compensation <br />fines up to one hundred thousand dollars ($100,000),in <br />the Labor Code, interest and attorney's fees. <br />and shall subject cmployer to criminal pcnalties and civil <br />addition cost of compcnsation, damages as provided for the Section 3076 of <br />LICENSED CONTRACTORS DECLARATION <br />I hacby aflim undq pcnalty of pcrjury tha I m licoscd unds prcvisio of Chapt6 9 (mmmcing with Srction 700O) of Dvision 3 of <br />thc Buins ud Profmios Codc, ud my liccnsc is in full forcc ud cffct. <br />License License Number <br />Date: Contractor: <br />CONSTRUCTION LENDING AGENCY <br />I hcrcby affim undo pcnalty of pcrjury th8t th@ is a constructio lcnding agocy fo thc pcrfmre of thc wck fil vhich this pcmit is <br />issucd (Scc. 3097, Civ. C.). <br />Lod6's Nmc: <br />Lender's Address: <br />APPLICAIYT'S DECLARATION <br />Demolition Permis-Asbestos Notification Federal Regulations (Titlc 40, Part 6) <br />_ Required Letter of Notification <br />that the federal regulations rcgarding asbestos removal are not applicable to this project. <br />certify that havc read this application and state that the above information rs colTect.agree to comply with allCity and County <br />County to cnter upon thcordinanccsandStateLawsrelatingtobuildingconstruction, <br />above mentioned property <br />Applicant or agcnt sig. <br />Permittec narne (print): <br />for inspection purposes. <br />and hereby authorize representatives of this City and <br />o